Endometriosis

Endometriosis (Endo) is a disorder in which the endometrium (the uterine lining) grows on the outside of the uterus instead. Endo doesn’t just affect the uterus – the ovaries, fallopian tubes and pelvic tissue can also be affected.

When the ovaries are affected, cysts (also called endometriomas) can form in some cases. Additionally, scar tissue and adhesions can develop due to irritated tissue in those areas.

Endometriosis Symptoms

Endometriosis may affect around 11% of American women aged 15-44[1] and is said to affect 6-10% of women of reproductive age.[2] On top of this, it can take around 10 years for an endo diagnosis on average (for a woman living in the U.S.)[3] The causes of endometriosis are still unknown, but there are several symptoms that can lead to a diagnosis:

Painful periods – Also called dysmenorrhea, your period may have unbearable menstrual cramps and pelvic pain. This is one of the biggest indicators of endo.
Periods lasting longer than 7 days.
Heavy bleeding – also called menorrhagia, this can include changing pads or tampons every few hours due to the amount. You may also experience bleeding between periods (called menometrorrhagia.)
Pain while pooping or peeing – this is usually seen during your period and can include diarrhea or constipation.

Endometriosis is difficult to diagnose and the ultimate way to by performing a laparoscopy. A laparoscopy is a minimally invasive surgery where a doctor examines the abdomen, uterus and ovaries with a camera via small incision near the belly button. During this procedure, a doctor takes a sample of the lining or suspected lesions for testing.[4]

How to Deal with Endometriosis Symptoms

While there is no cure for endo symptoms, there are various ways to deal with them:

Pain medication, such as ibuprofen, can lessen the painful cramps and backache of endo.
Birth control or other contraceptive pills can reduce the pain and make periods lighter and shorter.
Gonadotropin-releasing hormones (Gn-RH) can block ovarian stimulation, lower estrogen levels and prevent menstruation altogether. However, these drugs create a false menopause and women who use them may experience symptoms of menopause, such as hot flashes and bone loss.
Danazol, a drug that suppresses endometrium growth, can prevent periods and symptoms. However, it has serious side effects and is not a first choice action.
Conservative surgery to remove endo (either via laparoscopy or traditional abdominal surgery) can be performed to reduce pain. However, the endo may grow back and the pain can return.
Hysterectomy – a surgery to remove the uterus, cervix and ovaries – is also available as a last resort. However, this will result in the inability to have children.[6]

Endometriosis Stages

There are four stages to endo based on severity of the disorder:

Stage I – This “minimal stage” can include small lesions and swelling of pelvic organs.
Stage II – This “mild stage” is a bit more than the minimal stage, but damage is still slight, as are legions.
Stage III – This “moderate stage” sees more widespread damage, with tissue affecting the pelvic organs and side walls. Here, there may be some legions or scarring.
Stage IV – The “severe stage” features the endo affecting several organs (such as the pelvis and ovaries), which can lead to adhesions, cysts, or even distorted anatomy.[5]

Endometriosis and Infertility

Women with endo may have trouble getting pregnant; this is due to:

Distortion of the fallopian tubes, resulting in the tubes being unable to transfer the egg after ovulation, and
Inflammation that can affect function of the reproductive organs.

However, this does not mean that having a child is impossible. Treatments are available to help those that are struggling to conceive.

Conservative surgery (as described in the last section) has increased the chances of natural or spontaneous conception.[7] However, if this surgery is unsuccessful, assisted reproductive technology (ART) is the next step.

In mild cases (Stage II/Stage III), intrauterine insemination (IUI) is a possibility. Trying to conceive with IUI is better that no treatment, according to two trials.[8]

In vitro fertilization and embryo transfer (IVF-ET) can help those with endo conceive by eliminating the need for eggs to travel down the fallopian tubes. This procedure is best for those with tubal issues, male infertility factors, or previous treatment failures. Additionally, IVF-ET is the best course of action for those with Stage IV endo.

According to a 2010 study, surgery first and IVF-ET with no pregnancy produced a higher rate of clinical pregnancy versus surgery alone. However, every doctor is different.[9] Creating a plan of action with the reproductive endocrinologist (RE) that best fits your case is the best solution.

For more information on IUI or IVF, please visit the respective pages in the menu above.

[1] Buck Louis, Germaine M., Mary L. Hediger, C. Matthew Peterson, Mary Croughan, Rajeshwari Sundaram, Joseph Stanford, Zhen Chen, et al. 2011. “Incidence of Endometriosis by Study Population and Diagnostic Method: The ENDO Study.” Fertility and Sterility 96 (2): 360–65. https://doi.org/10.1016/j.fertnstert.2011.05.087.

[2] Rogers, Peter A W, Thomas M D’Hooghe, Asgerally Fazleabas, Linda C Giudice, Grant W Montgomery, Felice Petraglia, and Robert N Taylor. 2013. “Defining Future Directions for Endometriosis Research: Workshop Report from the 2011 World Congress of Endometriosis In Montpellier, France.” Reproductive Sciences (Thousand Oaks, Calif.) 20 (5). SAGE Publications: 483–99. https://doi.org/10.1177/1933719113477495.

[3] Smith, Lori, Wilson, Debra Rose. 2018. “What’s to Know about Endometriosis?” MedicalNewsToday. 2018. https://www.medicalnewstoday.com/articles/149109.php.

[4] “Endometriosis Symptoms, Treatment, Diagnosis.” n.d. UCLA Obstetrics and Gynecology. Accessed April 26, 2018. http://obgyn.ucla.edu/endometriosis.

[5] Duarte, Marta. 2017. “The 4 Stages of Endometriosis.” Endometriosis News. 2017. https://endometriosisnews.com/2017/07/13/stages-of-endometriosis/.

[6] Mayo Clinic. 2018. “Endometriosis.” Mayo Clinic. 2018. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656.

[7] Ziegler, Dominique de, Bruno Borghese, and Charles Chapron. 2010. “Endometriosis and Infertility: Pathophysiology and Management.” The Lancet 376 (9742). Elsevier: 730–38. https://doi.org/10.1016/S0140-6736(10)60490-4.

[8] Fadhlaoui, Anis, Jean Bouquet de la Jolinière, and Anis Feki. 2014. “Endometriosis and Infertility: How and When to Treat?” Frontiers in Surgery 1. Frontiers Media SA: 24. https://doi.org/10.3389/fsurg.2014.00024.

[9] Bulletti, Carlo, Maria Elisabetta Coccia, Silvia Battistoni, and Andrea Borini. 2010. “Endometriosis and Infertility.” Journal of Assisted Reproduction and Genetics 27 (8). Springer: 441–47. https://doi.org/10.1007/s10815-010-9436-1.